As the demand for educated and qualified nurses continues to grow, prospective nursing students might wonder how they can afford nursing school now to open their career possibilities over a lifetime.
If you have applied to schools and are receiving acceptances and award letters, it’s time to crunch the numbers to figure out the best choice for your money. Schools offer many awards including merit scholarships, grants based on merit or need, and loans that fall into many categories. You can also make some other adjustments to shave off some costs without impacting your education.
How do you know you can afford nursing school? Here are some questions to ask.
Will You Be a Full-time or Part-time Student?
Some colleges and universities award scholarships based on the student’s academic load. If you are trying to decide which route is for you, check with the schools to see if there is substantially more money available that could impact your choice. Consider your employment potential as well. Part-time status takes longer to complete, but you may be able to work and go to school (and your employer might pay for part of your education).
Where Will You Live?
Living on campus generally costs more money. Attending a college that’s closer to home lets you save thousands of dollars on campus housing and meal plan fees. If you are already living at home, you’ll save by continuing to live at home and commuting to school.
Can You Take a Hybrid Route?
Are there any online courses that cost less? If you are aiming for a BSN, could you take a prerequisite class and some of your basic classes at a cost-saving community college and then transfer to a four-year college to finish your degree?
What Aid Is Available?
A strong academic record and solid application will likely land you some merit scholarship funding. Like a grant, that’s money the school gives to you. You don’t have to pay it back, but you do need to find out if the award will be renewed each year you are at the school. If you apply to a four-year college, you need to know you can afford all four years.
How Much Debt Are You Willing to Take On?
After any merit or need-based scholarships and grants, you can be awarded loans. Loans always have to be paid back. Federal loans come from the government and while they have to be paid back, they often have low interest rates, and you don’t start repayment until after graduation. If federal loans don’t meet your entire need, you can apply for private loans, which have higher interest rates and varying repayment policies.
What Are Your Post-graduation Plans?
Some nurses can have some student debt forgiven if they apply for and fulfill the requirements of the NURSE Corps Loan Repayment Program. In addition, some states offer specific loan repayment or forgiveness plans for nurses.
Figuring out how to afford nursing school is going to be different for each student, but there are many options and choices available. For many students, finding the right balance just takes some investigating.
As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.
Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.
In 2017, BMC Medical Ethics published a systematic review assessing a decade’s worth of publications for implicit bias in health care professionals. The conclusions stated a need for additional reviews and more homogeneous methodologies, but determined that implicit bias exists in health care settings and impacts quality and equity of care. Authors Mahzarin Banaji and Anthony Greenwald address the issue in books like Blindspot: Hidden Biases of Good People, as does Augstus White, III, MD, in Seeing Patients: Unconscious Bias in Health Care.
Here’s how to pay attention and fix it.
Notice Your Assumptions
Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.
Understand What Assumptions Trigger in You
You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?
Know Why It Matters
An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.
Know Your Patient
Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.
Talk About It
You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.
Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.
Planting the health policy seed has become increasingly important to professional nursing organizations, nurse educators, and even nursing students who applaud the call for integrating health policy and advocacy content in today’s nursing curricula. As nursing students become acquainted with the policymaking process, they are also encouraged to familiarize themselves with the various professional and specialty nursing organizations who advocate on behalf of the nursing profession and the patients/consumers they serve.
Numerous nursing organizations including the American Nurses Association (ANA), National Council State Boards of Nursing (NCSBN), and National League for Nursing (NLN), to name a few, work to ensure that nursing’s voice is represented during policy discussions on issues that impact health care delivery, patient outcomes, nursing workforce development, and other issues of concern to the profession. These and other organizations advocate to ensure that students have financial support to attend nursing school, have access to loan repayment programs, and support to advance their nursing education and training. These organizations work diligently to help ensure that today’s nursing workforce is well prepared to meet the demands of providing high-quality health care services in an ever-changing complex and challenging health care environment.
In this article, we present information about the American Association of Colleges of Nursing (AACN) and share insights from AACN Chief Policy Officer Suzanne Miyamoto, PhD, FAAN, RN.
The American Association of Colleges of Nursing
Since 1969, AACN has been a leader in advancing nursing education, research, and faculty practice. Moreover, AACN serves as a national voice for baccalaureate and graduate nursing education. In addition to creating standards for designing and delivering quality nursing education programs, AACN represents over 810-member schools and colleges of nursing nationwide. The AACN has a Government Affairs Committee and a Health Policy Advisory Council that coordinate and spearhead several public policy initiatives and activities focused on advancing nursing education, research, and faculty practice. Currently, the association’s federal policy agenda focuses on four key areas: workforce, higher education, research, and models of care—all ongoing public policy imperatives.
Here, Miyamoto shares some insights about her organization and health policy advocacy.
Describe Your Role and the Role of the AACN in Preparing Today’s Nursing Students in Becoming Influential Advocates in the Health Policy Arena.
As Chief Policy Officer, I oversee AACN’s policy and advocacy work at the federal level working with all three branches of government. My role and that of our team can be described as strategist, lobbyist, and analyst. To ensure we meet the needs of our member organizations, the association has a Government Affairs Committee and Health Policy Advisory Council that provides guidance when we are reviewing legislative proposals or federal regulations. We want to ensure that what we support, oppose, or remain neutral on is in line with the experiences or challenges of our member institutions. AACN is in a unique position that we represent the schools of nursing, which includes the deans, faculty, and students. This requires our advocacy work to be nimble and abreast of the key issues Congress and the Administration are discussing. It is our role to not only develop the strategy but to educate and inform our membership on our position and why we take it. Information is the best offense and the best defense. That is why AACN fully supports all members of a nursing school to be engaged in our advocacy efforts. We have a grassroots network with other 11,000 students, faculty, and deans. This network has great potential to grow and offers real-time, advocacy opportunities.
What Are Some Top Priority Policy Issues Impacting the Profession and Health Care Today?
Some key issues impacting the profession today include
• Securing funding for Nursing Workforce Development Programs, Title VIII of the Public Health Service Act, National Institute of Nursing Research, National Health Service Corps, among others
• The Title VIII Nursing Workforce Reauthorization Act (H.R. 959, S. 1109)
• Health reform
• Deferred Action for Childhood Arrivals (DACA)
• Public Service Loan Forgiveness
• Opioid epidemic
What Can Students Do Within Their Area of Influence to Advocate for the Profession?
It is important that students stay informed of the issues. Students need to be active participants in their own learning. To understand what is happening at the federal level, a student must embrace the policy from multiple lens. It is not enough to read one source or one disciple. To truly garner the depth and breadth of the issue, the more voices, for and against, the better one’s understanding becomes. Securing a basic level of knowledge on an issue that may impact one’s education, research, or future practice is an excellent starting point.
Grassroots campaigns are central to any of our efforts. We can be more effective if we know how our national organizations are weighing in on issues. It’s also important to listen to all perspectives. Again, policy think tanks like the Center for American Progress or the Heritage Foundation may have different political viewpoints, but on some issues, they may see eye to eye. Their rationale for getting there may be different, but it is that difference that can help further an argument depending on the audience. Students can also join forces with faculty and others to reach out to legislators at the federal, state, and local level on issues important to nursing. Discussing issues with nursing faculty, who can serve as tremendous mentors for those interested in policy, can ignite a passion for this work in the future. That is how I came to seek a career in health policy and advocacy. It was the foresight of my faculty mentors who gave me the opportunities to succeed.
What Resources Are Available for Nursing Faculty Who Are Preparing the Next Generation of Health Policy Activists?
AACN established a Faculty Policy Think Tank that worked to prepare a set of recommendations for AACN’s Board of Directors on this exact question. The charge of the group was to inform and improve the state of health policy education in undergraduate and graduate education. The ultimate goal was to consider ways that will help create a generation of future nurses who understand the micro and macro drivers that impact policy—most importantly, how nurses in the future can continue to skillfully insert nursing expertise into policy discussions. The report was released in October 2017.
Turning to the continued need for policy advocacy at the student level, AACN also offers a three-day student policy summit open to undergraduate and graduate nursing students enrolled at AACN member institutions. The program helps to prepare students to engage in policy advocacy and the federal policymaking process. For more information, visit http://www.aacnnursing.org/Policy-Advocacy/Get-Involved/Student-Policy-Summit.
As mentioned earlier, AACN’s 2017–2018 Federal Policy Agenda is well suited to serve as a foundation for shaping policy discussions during online and classroom discussions as well as during virtual and/or actual lobby days. Students are encouraged to speak with their deans and faculty at their nursing programs to learn more about what’s happening within their institutions regarding public policy advocacy efforts that impact nursing education and nursing practice.
Seeking Federal Support for Nursing Workforce Development Programs: A Clarion Call for Continued Advocacy
Very central to this discussion is the need for ongoing advocacy to secure funding to support Title VIII programs. Title VIII programs are administered under the U.S. Department of Health and Human Services, Health Resources and Services Administration. The Nursing Workforce Development Program (Title VIII of the Public Health Service Act) continues to benefit countless numbers of nursing programs, practicing nurses, faculty, students, patients, and communities. In fact, numerous minority nurses continue to benefit from diversity grants because of Title VIII funding. During 2015–2016, the Nursing Workforce Diversity grants supported 7,337 students. Numerous other minority nurses, including minority nurse faculty, have received funding through this program to support their advanced nursing education or pay back student loans. To learn more about how Title VIII programs are making a difference for nursing students, practicing nurses, academic institutions, and communities at large, visit http://www.aacnnursing.org/Policy-Advocacy/Title-VIII-Community-Impact.
As a nursing student, speak with your faculty and professional organizations about how you can play a role in policy advocacy. Throughout nursing’s history, nurses have made a tremendous impact in advancing the profession and the delivery of health care by advocating for issues of importance to them. Developing your knowledge base about these and other issues impacting the profession is a great first step to becoming an influential advocate on behalf of the profession and the patients and communities you serve.
After four years of rigorous schoolwork while working as a full-time assistant professor, I was physically and mentally spent when I started writing my doctoral dissertation. But despite this unimaginable exhaustion, I felt inspired, empowered, and euphoric because now, I could see the light at the end of the tunnel. I was almost at the completion of something I had worked so hard to accomplish. It took me almost a year to complete my dissertation while working overseas in Okinawa, Japan. I remember how writing the last chapter of my dissertation was the most challenging, as I was getting more impatient just to present and defend my research. Throughout this entire experience, I found my positive self-talk helpful each time I found myself unmotivated to get going: “Just try to write, even if it is just for a few minutes.” So, that was what I did.
I struggled with this dissertation at the worst time of my life. I was just about to start my dissertation when my mother’s health began to deteriorate. Almost three decades ago, I left my family in the Philippines, the people who had given me everything to be where I am today, to move to America. I felt obligated to take care of my mother. To be closer to her, I decided to take an overseas job and move temporarily to Okinawa, Japan. However, her condition turned worse, and she finally passed away after months of being in a vegetative state. To say that I was in a state of turmoil is an understatement.
My parents never graduated from college, but they understood the value of education. They worked very hard to support us and never asked us to help them. For them, our only job was to go to school and obtain a college degree someday. My doctorate was my greatest tribute to my mother’s sacrifices for her children’s education, but she did not live long enough to see it. My grief made me temporarily lose my motivation. Grief is a very uncomfortable place to be stuck. It is so easy to get trapped in that paralyzing sadness. Many times, I had to convince myself not to give up: “Give it a go because you’ve come this far. Don’t give up.” This self-talk served me well when I almost lost all my will and determination to complete my dissertation. With the help of my family and academic advisors, I was able to deal with my sadness my way to be able to move on. Their understanding and patience allowed me to feel, say, and think whatever it was I needed to heal. In the end, my dissertation saved me and gave me back my focus.
The road to success is not easy to navigate, even for the most talented people. Would I have predicted that my life would turn out this way three decades after my husband and I moved to America? No. I came from a rural area in Cebu, Philippines, a typical small town devoid of big city luxuries. I was shy as a child because I felt so insignificant. My past is consequential to who I am today. To remember my humble beginnings is important to me. My roots made me who I am today.
When I started my doctoral program, I was extremely excited but was also very intimidated. I felt intensely inferior to the other students because they all seemed smarter and better educated than I was. With English as my second language, academic writing did not come easy. My insecurities and self-doubts were the driving forces that made me work harder. I probably studied twice as hard and wrote twice as long as everyone else. I worked harder and longer to compensate for my shortcomings. I still remember how I struggled during my first course and how frustrating it was when I accidentally erased my paper and had to write another one. My will and determination helped me to overcome my fear of failing. Writing my dissertation has been the most demanding, exhausting, yet highly rewarding endeavor in my life. It was a long and arduous journey not just for me but also for my husband and sons who had supported me throughout the process. From my experience, it is easy to get lost along the way, procrastinate, and give in to distractions. But with perseverance and hard work, the finish line is attainable.
I will always remember what my father taught me to help me overcome my inferiority complex as a child: “The harder you work, the luckier you get.” My life would have been completely different if I took a different path 25 years ago. As a first-generation immigrant in the United States, I am proud that I have gotten this far. Of course, there were many hardships and setbacks, but there were also many successes in my life. The little successes I had slowly built my confidence so that over time, I started to believe that I could dream big.
It has been a year since the conferral of my doctoral degree. It was a transformative process for me, a self-discovery experience of how much I could persevere to accomplish something I consider worthwhile. My graduation was a life-fulfilling moment for me—an accomplishment of a lifetime that I am so proud and grateful. The experience made me realize that I am more than I ever thought I was. It changed me. I came out stronger and better. Although it was largely an intellectual endeavor, the physical endurance to multitask and the emotional resilience to persevere when life-changing events happen were critical elements that made my dream a reality. Because I overcame my fears and shortcomings, I came out more hopeful of what the future brings.
We all sat around in my living room, friends in the fight against those nursing school teachers who seemed hell-bent on making our lives miserable. There were about ten of us crammed into my small living room for this Saturday study group, and I was the de facto leader. I didn’t need to be there. I didn’t need much more than to glance through the notes to get good grades, but I wanted to help these on-the-bubble students pass. I taught what I knew. Everyone wanted to study with me because, well, test scores speak for themselves in nursing school.
Yes, I was one of those, and I always have been. Give me a book, and I can ace a test. It isn’t really genius. It’s just that I know how to take a test. Of course, I was immensely proud of my 4.0. I didn’t lord it over people, but I did feel rather smug I guess, rather superior. I felt this meant the nursing world was my oyster. I was cocky that I would breeze through orientation, but I certainly didn’t feel I knew it all. I also didn’t put my fellow students down. In fact, I enjoyed helping them, fighting the good fight to get them to pass.
One day, my teacher said something that made the bottom drop out of my stomach: “The best nurses are usually those in the middle of the pack. Those who score high tend to not do so well.”
Was she talking to me? She said it to the class, but was she talking to me?
Maybe I was paranoid, but it turns out that there was a kernel of truth in what she said.
When I interviewed out of nursing school, no one cared that I graduated at the top of my class, although I told them repeatedly. They were more interested in how I would handle a crisis and what sort of person I was and whether or not I would fit in with this culture. Despite my obvious hubris, I am actually someone who can work well with others, can care for patients, and can be a part of the team. The only thing is that my work in school didn’t matter a damn to them.
What really opened my eyes was orientation. I was lost. Everything I had learned was so much chaff. It came into play from time to time, but it really and truly did not matter.
I remember the first time I had four patients. It was a juggling act. The fact that I knew all the bones of the hand by heart was completely irrelevant. I needed to look at vital signs and know what they meant. I needed to know when to pass meds and when to chart. Most importantly, I needed to know when I didn’t know something, and I needed to ask for help.
Fortunately, questions have never been a problem for me, and I was able to become a safe nurse because of that. This 4.0 student spent more time with her preceptor or charge nurse than she did with her patients in the first year of nursing.
And still, all that book learning I had was merely peripheral. Sometimes, it came into play. I would know obscure things about electrolyte imbalances, for instance. I was also considered one of the go-to nurses with problems in my later years.
But my knowledge is not what makes me a good nurse.
I found that my personal sense of patient safety was the most important. My ability to handle more and more stress became the calling card of my practice. My life was about looking at a situation and making a decision. Do I call a doctor about this, or do I have the means to fix it myself? Do I delegate this responsibility, or do I do it myself? Should I ask for help, or do I know enough?
My mentors—my preceptor, my manager, the various charge nurses, and the more experienced nurses—made me into a nurse. It wasn’t that huge book I lugged around for so many years. It takes a village to raise a nurse. Not a textbook.
These are skills that are not measured by GPA. These are skills that I have but don’t come as easily to me as multiple-choice questions. The point is that if you are a 2.5 student, don’t worry. Your ability to pass tests and get good grades has nothing to do with real world nursing. Trust me. I’ve been there. I am a good nurse. I worked hard to become one, but it didn’t have anything to do with what I did in school. It was about a fabulous preceptor, a supportive group of experienced nurses, and hard work on my part.
Not graduating at the top of your class? You may just be the best nurse yet. If you are someone who can manage your time well, you will make a good nurse. If you are someone who can stare down a stressful situation and make decisions, you will be a good nurse.
Most importantly, if you can and will ask questions when you don’t know the answers—and accept that you know very few of the answers—you will be well on your way to becoming a fantastic nurse. If you just eked by in nursing school, don’t let it bother you. Take it from someone who has been there: It doesn’t matter at all.
One of the most commonly heard phrases right from day one of nursing school is “critical thinking.” The common consensus is that everyone has to develop sound critical thinking in order to be a safe and effective, registered nurse (RN). This necessity is magnified when it comes to critical care areas where one decision by the RN can change the patient’s outcome. Nursing has changed from a simple caregiving job to a complex and highly responsible profession. Hence, the role of nurses has changed from being task-oriented to a team-based, patient-centered approach with an emphasis on positive outcomes. Strong critical thinking skills will have the greatest impact on patient outcomes.
So, what is critical thinking and how do we develop this? A precise definition was proposed in a statement by Michael Scriven and Richard Paul at the Eighth Annual International Conference on Critical Thinking and Education Reform during the summer of 1987. “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness,” reads the document.
Simply put, critical thinking in nursing is a purposeful, logical process which results in powerful patient outcomes. “Critical thinking involves interpretation and analysis of the problem, reasoning to find a solution, applying, and finally evaluation of the outcomes,” according to a 2010 study published in the Journal of Nursing Education. This definition essentially covers the nursing process and reiterates that critical thinking builds upon a solid foundation of sound clinical knowledge. Critical thinking is the result of a combination of innate curiosity; a strong foundation of theoretical knowledge of human anatomy and physiology, disease processes, and normal and abnormal lab values; and an orientation for thinking on your feet. Combining this with a strong passion for patient care will produce positive patient outcomes. The critical thinking nurse has an open mind and draws heavily upon evidence-based research and past clinical experiences to solve patient problems.
How does one develop critical thinking skills? A good start is to develop an inquisitive mind, which leads to questioning, and a quest for knowledge and understanding of the complex nature of the human body and its functioning. A vital step in developing critical thinking for new nurses is to learn from those with a strong base of practical experience in the form of preceptors/colleagues. An open-minded nurse can learn valuable lessons from others’ critical thinking ability and will be able to practice for the good of their patients.
Critical thinking is self-guided and self-disciplined. Nursing interventions can be reasonably explained through evidence-based research studies and work experience. A strong sense of focus and discipline is also important for critical thinking to work. If thinking is unchecked, nurses can be easily misguided and deliver flawed patient care. A constant comparison of practice with best practices in the industry will help guide a nurse to think critically and improve care. This makes it easier to form habits which continue to have a positive impact on patients and colleagues. Every decision a critical thinking nurse makes affects not only the patient but also his or her families, coworkers, and self.
In summary, the take-home message for nurses is that critical thinking alone can’t ensure great patient care. A combination of open-mindedness, a solid foundational knowledge of disease processes, and continuous learning, coupled with a compassionate heart and great clinical preceptors, can ensure that every new nurse will be a critical thinker positively affecting outcomes at the bedside.